Healthcare Provider Details

I. General information

NPI: 1619758216
Provider Name (Legal Business Name): BALTIMORE MEDICAL SYSTEM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2023
Last Update Date: 09/02/2025
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 EASTERN AVE STE 202
BALTIMORE MD
21224-2796
US

IV. Provider business mailing address

5525 EASTERN AVE STE 301
BALTIMORE MD
21224-2796
US

V. Phone/Fax

Practice location:
  • Phone: 410-732-8800
  • Fax:
Mailing address:
  • Phone: 410-732-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: SHIRLEY SUTTON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 410-558-4891